Medical doctors and mental health professionals are finally talking

Even on her worst days, Tracy Young goes to her appointments at the San Fernando Mental Health Center. The counseling and medication, she says, keep her depression and schizophrenia at bay.

“I come here faithfully,” said Young, 50. “I have to come here or I be feeling I just want to give up.”

Young isn’t nearly as religious about her physical health, despite painful arthritis, a persistent back ache and a family history of cancer. Until this month, she hadn’t seen a medical doctor in more than three years.

People with severe mental illness are more likely to die prematurely than those without, often from treatable chronic diseases — in part because many, like Young, don’t receive regular medical care. They may be uninsured or unable to find doctors who take their insurance. They may be reluctant to seek care in traditional medical offices because of stigma or discrimination.

Even when they do have medical appointments, their doctors rarely communicate with their mental health providers. Experts said the lack of coordination can lead to medication problems, higher health costs and gaps in care.

Now, though, providers are beginning to bridge the gap between medical and mental care, forming partnerships aimed at improving patients’ physical and mental health, and reducing costs at the same time. Such holistic projects are underway in numerous states, including California, New York, Washington, and Florida.

“There has been a sea change in attitudes,” said Garrett Moran, who directs an academy on the integration of behavioral health and primary care for the federal Agency for Healthcare Research and Quality. “If we are going to bend the cost curve, the integration of behavioral healthcare and physical healthcare is essential.”

Moran said the old model — simply referring patients with mental illness to a primary care doctor — doesn’t work. Instead, the patients need close, coordinated monitoring by both providers.

“Any chest pain, shortness of breath, headaches?” he asked.

“I have headaches — pounding,” she said. “I have a headache right now.”

“Any asthma? High blood pressure? Diabetes?” he continued.

“That’s why I came here,” she replied, explaining that she hadn’t had a medical test in three years. “I need you to tell me that.”